Lupattelli and colleagues, analyzing data from the prospective Norwegian Mother and Child Cohort Study, look at the impact of prenatal SSRI exposure on children’s behavior.  Another study documents the deleterious effects of valproic acid exposure on children’s cognitive development (Elkjær et al, 2018). And a handful of studies looking at screening for perinatal depression and how to improve delivery of care to this vulnerable population.

Ruta Nonacs, MD PhD

Effect of Time-Dependent Selective Serotonin Reuptake Inhibitor Antidepressants During Pregnancy on Behavioral, Emotional, and Social Development in Preschool-Age Children.
Lupattelli A, Wood M, Ystrom E, et al.  J Am Acad Child Adolesc Psychiatry, 2018.

These findings suggest no substantial increased risk for externalizing, emotional, and social problems in preschool-age children following prenatal SSRI exposure. While the role of chance and potential unmeasured confounding cannot be ruled out, late-pregnancy SSRI exposure was associated with greater anxious/depressed behaviors in the offspring.

Association Between Prenatal Valproate Exposure and Performance on Standardized Language and Mathematics Tests in School-aged Children.

Elkjær LS, Bech BH, Sun Y, Laursen TM, Christensen J.  JAMA Neurol. 2018 Feb 19.

Maternal use of valproate was associated with a significant decrease in school performance in offspring compared with children unexposed to AEDs and children exposed to lamotrigine. Findings of this study further caution against the use of valproate among women of childbearing potential.

Moving beyond depression screening: integrating perinatal depression treatment into OB/GYN practices.

Terrazas C, Segre LS, Wolfe C.  Prim Health Care Res Dev. 2018 Feb 12:1-9.

Listening Visits (LV), developed for delivery by nurses and validated in the United Kingdom, have recently been evaluated in a US-based randomized controlled trial (RCT) which recruited research participants from three home-visiting programs and an urban OB/GYN practice. RCT results indicated clinically and significant improvement in depression symptoms. This paper proposes a strategy for implementing depression screening and LV into routine clinical care delivered in OB/GYN practices.

Positive postpartum depression screening practices and subsequent mental health treatment for low-income women in Western countries: a systematic literature review.

Hansotte E, Payne SI, Babich SM.  Public Health Rev. 2017 Jan 31;38:3. Free Article

Characteristics of successful mental health treatment included studies that employed the use of a home visitor and those that separated outcomes for women with previous mental health treatment. Themes that emerged as treatment obstacles included cultural barriers, physical barriers, systemic health care barriers, and social barriers.

Digital Peer-Support Platform (7Cups) as an Adjunct Treatment for Women With Postpartum Depression: Feasibility, Acceptability, and Preliminary Efficacy Study.

Baumel A, Tinkelman A, Mathur N, Kane JM.  JMIR Mhealth Uhealth. 2018 Feb 13;6(2):e38.  Free Article

7 Cups of Tea (7Cups), a digital platform delivering self-help tools and 24/7 emotional support from trained volunteers, may serve as an adjunct treatment for mothers diagnosed with PPD.  Participants (n=19) proactively logged into 7Cups for a median of 12 times and 175 minutes. Program use was mostly through the mobile app (median of mobile use 94%) and between 18:00 and 08:00 when clinicians are unavailable (68% of total program use time). Participants chatted with volunteers for a total of 3064 minutes and have indicated in their responses 0 instances in which they felt unsafe. Intent-to-treat analysis revealed that 7Cups recipients experienced significant decreases in EPDS scores (P<.001, Cohen d=1.17). No significant difference in EPDS decrease over time was found between 7Cups and TAU, yet the effect size was medium favoring 7Cups (P=.05, Cohen d=0.58).

Frequency, trends, and antecedents of severe maternal depression afterthree million U.S. births.

França UL, McManus ML.  PLoS One. 2018 Feb 14;13(2):e0192854. Free Article

Examination of the Healthcare Cost and Utilization Project (HCUP) State Inpatient, Emergency Department, and Ambulatory Surgery and Services Databases from California (2005–2011) About half (1,661/3,325) of PPD first episodes occurred within 34 days of delivery, 70% (2,329/3,325) by the end of the second month, and 87% (2,893/3,325) before four-months of the delivery. Women with private insurance were less likely to have hospital encounters for depression than women with public insurance and women with depression were much more likely to have had some kind of hospital encounter at some time during their pregnancies. Rates of depression increased with the number of prenatal hospital encounters in a “dose-dependent” fashion: the rate of depression was 17.2/10,000 for women with no prenatal hospital visits, doubling for women with at least one encounter (34.9/10,000), and increasing 7-fold to 126/10,000 for women with three or more encounters during their pregnancies.

Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries.

Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I.  Front Psychiatry. 2018 Feb 1;8:248.    Free Article

291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7%, with significant heterogeneity across nations, ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality, maternal mortality, infant mortality, or women of childbearing age working ? 40?h a week have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence.

Non-pharmacological interventions for improving postpartum maternal sleep: A systematic review and meta-analysis.

Owais S, Chow CHT, Furtado M, Frey BN, Van Lieshout RJ.  Sleep Med Rev. 2018 Jan 31.

Massage and exercise interventions had the largest impact on maternal sleep quality. Positive effects on nocturnal infant sleep were found for interventions overall but not for maternal depression.

Adverse childhood experiences and depressive symptomatology among pregnant women.

Ångerud K, Annerbäck EM, Tydén T, Boddeti S, Kristiansson P.  Acta Obstet Gynecol Scand. 2018 Feb 12.

EPDS scores were positively associated with the number of adverse childhood events (ACEs), cigarette smoking before pregnancy, body mass index and psychiatric disorders while education level was inversely associated with risk for depression. Among women with an ACE score ?5 the odds ratio of having an EPDS score indicating probable depression was 4.2 (CI; 2.5-7.0).

White matter integrity in medication-free women with peripartum depression: a tract-based spatial statistics study.

Silver M, Moore CM, Villamarin V, Jaitly N, Hall JE, Rothschild AJ, Deligiannidis KM.  Neuropsychopharmacology. 2018 Feb 5.

Diffusion tensor imaging (DTI) studies in depression show decreased structural connectivity in the left anterior limb of the internal capsule and the genu of the corpus callosum.  Similar findings were observed in women with peripartum depression.

Low serum levels of High-Density Lipoprotein cholesterol (HDL-c) as an indicator for the development of severe postpartum depressive symptoms.

Ramachandran Pillai R, Wilson AB, Premkumar NR, Kattimani S, Sagili H, Rajendiran S.  PLoS One. 2018 Feb 14;13(2):e0192811.

Lower serum levels of Total Cholesterol (TC) and High Density Lipoprotein cholesterol (HDL-c) were associated with severe depressive symptoms at six months postpartum.

A systematic review of the associations between maternal nutritional biomarkers and depression and/or anxiety during pregnancy and postpartum.

Trujillo J, et al.  J Affect Disord, Feb 2018.

Thirty-eight studies were reviewed. Low serum vitamin D was associated with pre/postnatal depression. Fatty acids and depression and anxiety had divergent or no associations.clinical practice on nutritional biomarkers.

Treatment of depression with Chai Hu Shu Gan San: a systematic reviewand meta-analysis of 42 randomized controlled trials.

Sun Y, Xu X, Zhang J, Chen Y.  BMC Complement Altern Med. 2018 Feb 17;18(1):66. Free Article

Chai Hu Shu Gan San, is a traditional Chinese medicine. A meta-analysis showed Chai Hu Shu Gan San was more effective than fluoxetine for pure depression (MD?=???1.59, from ??2.82 to ??0.37, 4 trials, I2 =?26%) and for postpartum depression (MD?=???4.10, from ??7.48 to ??0.72 7 trials, I2 =?86%).

Postnatal depression in a community-based study of women with polycystic ovary syndrome.

March WA, Whitrow MJ, Davies MJ, Fernandez RC, Moore VM.  Acta Obstet Gynecol Scand. 2018 Feb 20.

A positive but statistically non-significant association was found between PCOS and postpartum depression (OR=1.6, 95% CI 0.9-2.9).

The role of sleep difficulties in the vasomotor menopausal symptoms and depressed mood relationships: an international pooled analysis of eight studies in the InterLACE consortium.

Chung HF, Pandeya N, Dobson AJ, Kuh D, Brunner EJ, Crawford SL, Avis NE, Gold EB, Mitchell ES, Woods NF, Bromberger JT, Thurston RC, Joffe H, Yoshizawa T, Anderson D, Mishra GD.  Psychol Med. 2018 Feb 12:1-12.

In a pooled analysis using data from 21,312 women,  the prevalence of VMS (40%, range 13-62%) and depressed mood (26%, 8-41%) varied substantially across studies, and a strong dose-dependent association between VMS and likelihood of depressed mood was found. Difficulty in sleeping largely explained the relationship between VMS and subsequent depressed mood, but it had little impact on the relationship between depressed mood and subsequent VMS.